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Key Differences Between the Next Gen NCLEX and the Traditional NCLEX


Rachel Baker

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If you’re a nursing educator, you’ve probably been hearing a lot about the Next Gen NCLEX, which is launching on April 1, 2023.

You may be wondering why the exam was updated and how you can help your students prepare for it.

Here’s why the NCBSN is adopting the Next Gen NCLEX

The main idea behind the Next Gen NCLEX is to better prepare nursing students to be safe and effective nurses. Researchers have found that around 50% of novice nurses are involved in nursing errors. According to the National Council of State Boards of Nursing (NCSBN), many of these nursing errors result from poor clinical decision-making.

With a goal of improving patient care, the NCSBN designed the Next Gen NCLEX to focus more on assessing clinical decision-making through case studies and more realistic questions. This means that preparing for the Next Gen NCLEX will prepare your students even better for their first day as a nurse.

6 New Things in the Next Gen NCLEX

In this article, you’ll learn about what’s new in the Next Gen NCLEX and how this updated test differs from the Traditional NCLEX. You’ll also get some resources that will help you prepare your students to succeed on the exam and on exam day.

1. New focus: Clinical judgment and the NCJMM

Clinical judgment is a big part of real-life nursing practice. Nurses use clinical judgment when they observe and put together clues about a patient’s needs, and when they use that information to make hypotheses about the underlying issues. They also use clinical judgment when they decide on treatments to recommend and evaluate how those treatments affected the patient.

Clinical judgment combines clinical thinking and decision-making.

NCSBN researchers developed the NCSBN Clinical Judgment Measurement Model (NCJMM) based on the current nursing literature, discussions with nursing experts, and analysis of data from more than 200,000 NCLEX candidates. This model allows them to assess candidates’ clinical judgment in a more detailed and reliable way.

The NCJMM specifies six cognitive aspects of clinical decision-making that it assesses using the new case studies and stand-alone questions in the Next Gen NCLEX.

Six cognitive aspects of clinical decision-making:

  1. Recognize cues – What matters most?
  2. Analyze cues – What could it mean?
  3. Prioritize hypotheses – Where do I start?
  4. Generate solutions – What can I do?
  5. Take actions – What will I do?
  6. Evaluate outcomes – Did it help?

2. New case studies

In order to better reflect the reality of nursing and to assess clinical judgment, the Next Gen NCLEX includes three realistic unfolding case studies, each with six questions. The case studies appear at the beginning, middle, and end of the exam.

Each of the six questions in a case study is independent and scored separately. All of the information required for a question is visible on that question, and candidates cannot go back to view or change earlier responses. In the case studies, key information is presented in tabs like Nurses Notes, Vital Signs, and Diagnostic Results, to mimic what candidates will see on the job. The six questions in a case study cover the six cognitive aspects of clinical decision-making in order, starting with recognize cues, and ending with evaluate outcomes.

3. New question formats in the Next Gen NCLEX

The Next Gen NCLEX includes five new question formats which are used in both case studies and stand-alone questions, and a sixth new question format (Bow-tie) used only in stand-alone questions. You can download and practice with sample case studies and questions at

New question formats

  • Extended Multiple Response
  • Select one or more of the response options
  • This is like the Multiple Response questions in the Traditional NCLEX, but includes more response options
  • Extended Drag and Drop
  • Move response options into answer spaces
  • This is like the Traditional NCLEX’s Ordered Response questions, but not all response options may be required
  • Cloze / Drop-down
  • Select one response option from a drop-down list in a sentence, table, or chart
  • Enhanced Hot Spot
  • Read a patient medical record and select the answer to the question by highlighting pre-defined words or phrases in the record
  • Matrix / Grid
  • Select one or more response options for each column or row in a table
  • Bow-tie
  • Drag responses from the relevant columns into answer spaces, selecting:
  • two actions to take
  • one condition
  • two parameters to monitor

There are two types of stand-alone clinical judgment questions.

  • Trend items:
  • Require candidates to review and make decisions about information collected over time
  • Test multiple cognitive aspects of clinical decision-making
  • Can use any question format
  • Bow-tie items:
  • Require candidates to read a scenario and select the most likely cause of the patient’s issues, the actions to take, and the parameters to monitor
  • Test all six cognitive aspects of clinical decision-making in a single question
  • Use the new Bow-tie question format

4. No more memorization – normal reference ranges are included

Unlike the Traditional NCLEX, the Next Gen NCLEX provides the normal reference range on questions that use a numeric laboratory value. This is to better reflect a practicing nurse’s experience, as reference ranges are generally presented with lab results.

This means that your students no longer have to memorize reference ranges when studying for the Next Gen NCLEX!

5. Partial Credit for Partial Understanding: a new scoring method in the Next Gen NCLEX

The final innovation in the Next Gen NCLEX is an updated scoring method. In the Traditional NCLEX, each question was scored as correct or incorrect. In contrast, the Next Gen NCLEX allows partial scores on single questions with multiple parts.

Here’s an example to explain how this works:

Imagine a Multiple Response question with options A-E, where the correct answers are selecting A, B, and E.

In the Traditional NCLEX, this question would be marked as incorrect if a candidate selected some, but not all, of the right answers (A and B, but not E). Of course, it would also be marked incorrect or a student selected only wrong answers (C and D).

What’s changed is that the Next Gen NCLEX gives nursing students a better score for selecting some of the right answers. In this way, the Next Gen NCLEX allows partial credit for partial understanding.

6. Updated test plans

Both NCLEX-RN and NCLEX-PN have updated test plans for the Next Gen NCLEX. Test plans include the percentage of questions on each topic category (e.g. Safety and Infection Control, Health Promotion and Maintenance, and Reduction of Risk Potential) and include a list of topics that could be covered in each category.

The 2023 test plans for the Next Gen NCLEX state that clinical judgment processes are measured in 18 questions across three case studies, and in around 10% of stand-alone questions. Other than this change, the target percentage of questions in each category is similar (within 2%) or identical in the Next Gen and Traditional NCLEX tests.

The Next Gen NCLEX has slightly higher minimum and maximum numbers of questions (85-150 questions) compared to the Traditional NCLEX (75-145 questions).

Summary of similarities and differences

The Next Gen NCLEX has been updated in some key ways to better reflect nursing reality. However, it still shares many features with the Traditional NCLEX.

Similarities between the Next Gen and Traditional NCLEX

  • Both versions of the NCLEX have similar numbers of questions (although minimum and maximum numbers of questions are slightly higher for Next Gen NCLEX), and candidates are still given five hours to complete the test.
  • All accommodations that were available for the Traditional NCLEX are available for the Next Gen NCLEX, and the method for requesting accommodations remains the same.
  • Both versions of the test use Computer Adaptive Testing (CAT). This means that the system chooses questions based on how a candidate answered earlier questions. It presents harder questions if a candidate answered earlier questions correctly, and easier questions if they answered incorrectly. This also means that both tests are variable lengths. After a minimum number of questions, the test will end when the system has enough confidence that a candidate is either above or below the passing standard.
  • The testing system’s pass / fail decision rules are the same in both versions, based on its confidence in its estimation of a candidate’s ability, the maximum amount of time available, and the maximum number of questions available.

Differences between the Next Gen NCLEX and Traditional NCLEX

  • The Next Gen NCLEX has a greater focus on clinical judgment, measured through case studies and new question types.
  • It provides reference ranges for numeric laboratory values.
  • It offers partial scoring on certain questions, giving credit for answers that are partially correct.

How to prepare pre-licensure nurses for the Next Gen NCLEX

With more realistic questions and a greater focus on clinical judgment, there’s no question that success on the Next Gen NCLEX requires a background of solid clinical practice. What makes this tricky is that the quality of students’ clinical experiences varies widely. In addition, they likely receive less mentoring now than they did before the nursing shortage became critical.  

That’s where UbiSim’s immersive VR simulation training for nurses can be helpful in preparing pre-licensure nurses for the exam.

Using simulated scenarios is the next best thing to being in person with real patients. Giving students exposure to different patients, different disease processes, and different outcomes in a VR simulation will support students to achieve both high scores on the Next Gen NCLEX and a high standard of patient care throughout their careers as practicing nurses.

Each UbiSim scenario empowers learners to use the six cognitive steps of clinical judgment, from recognizing and analyzing cues and prioritizing and implementing interventions to evaluating whether their actions were effective to help the patient.

You can experience UbiSim’s immersive VR simulation platform yourself by requesting a UbiSim demo.


The key differences between the Next Gen NCLEX and the traditional NCLEX are all aimed at assessing whether a pre-licensure nurse is ready for real-life nursing practice. With a supportive faculty and the right tool to help bridge the gap between coursework and clinical experiences, there’s every reason for nurse educators to continue to expect NCLEX high pass rates from their nursing students. In summary, changes in the exam include:

  • New focus on clinical judgment (as defined by the NCJMM)
  • Three sections with realistic unfolding case studies
  • Six new question format types
  • The provision of normal laboratory reference ranges (no memorization required)
  • New partial credit scoring method
  • Updated test plans with a new total number of questions on each topic category

Interested in trying UbiSim in your healthcare institution?
Request a Demo
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